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Things Discussed on Episode:
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Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!
Things Discussed on Episode:
You're listening to the pandemic podcast. We equip you to live the most real left hospital in the face today's crisis. My is Matt Boettger and I'm joined with my good friend, Dr. Stephen Kissler and epidemiologist at the Harvard School of Public Health. Happy new year, buddy.
Stephen Kissler:Happy new year. You're doing
Matt Boettger:really well. Welcome to 2021.
Stephen Kissler:Oh boy. Well, you know, that's a, that's a relief in a way.
Matt Boettger:And like starting off strong with a little bit of COVID variant, that's enough to get away to start
Stephen Kissler:testing. That's just what we need,
Matt Boettger:what we need. We'll talk about that in just a minute. Let's get a few things out of the way first and foremost. How are you doing? You've been working on some stuff and going, I, you told me off the record that you had an incredible new year's Eve by just working.
Stephen Kissler:Yeah. Yeah. That was that was my glamorous new year this year. So we're just got some deadlines coming up that always come up at the end of the year, like at the beginning of the new year. So it was just pushing to get that done. And then we'll hopefully take a few days to breathe after that.
Matt Boettger:Did you get to watch the ball drop in New York with like the 10 other people in New York in times square?
Stephen Kissler:I, I did not. I was, I was, I was really hoping it would just be like this big, like glistening coronavirus, but this
Matt Boettger:is sort of like, just send it and then just explodes. Yeah. There's like a big vaccine needle coming in at the
Stephen Kissler:That's the kind of hope we need this year.
Matt Boettger:Why did they not consult you for the New York tee ball drop? They've been awesome. Yeah, we I couldn't believe that last year. Right before it was crazy. We had a wonderful new year's Eve party with some friends in the mountains, and it was easy to find a Netflix like countdown for the boys, you know, the, we can do it early. Right. So I thought, Oh my gosh, this year it's going to be tons of them. Cause Eric at home, I couldn't find one. So we, we rushed to find a random one and then put them to bed a little early and had a little time to ourselves and we actually made it to midnight. We usually don't. Yeah. I'm 42. I just want to go to bed sometimes. So it was crazy. We, yeah. On our house. It's always crazy. Cause this time of the year in three weeks now in three weeks time, we celebrate our 10 year anniversary. Had Christmas had my eldest son's birthday. And then had new year's Eve new year's day and then celebrated my youngest son's birthday yesterday. So that was all in three weeks period. It was a large hurrah. Now in two more weeks, we have two more birthdays coming up. And then we'll be done for a while. So it has been good. It was a grownup full time to celebrate our youngest Everett's birthday turned three. It's one of those moments for us, just kind of a bittersweet. It was more than sweet. It's like wonderful. But three years ago, my wife gave birth to our third and last child and she nearly died. Died on giving birth to our last one. So it was a, it's a, it's, it's a wonderful time to celebrate, but it's also kind of one of those times where it's a little hard to think about this. My wife just she was, she pretty much hemorrhaged for about hour and a half afterwards. And thankfully she had an emergency hysterectomy to save her life. And so good news is we're all healthy. It's all wonderful. It's all beautiful. But we still have the memory, which kind of gives it a little bit of a different perspective. So you know, to make things a little bit lighter and a lighter note, it's almost kind of funny. Cause I feel like our middle child literally has middle child syndrome to the fullest extent because our first one was born on Christmas day, which was immensely, remarkably memorable. Right. Our last one, not. Remarkably memorable on the other, on the other side of the spectrum. And then I'm like, how were you born, Jude? I don't remember.
Stephen Kissler:You were somehow
Matt Boettger:you were kind of the normal. Yeah. So literally the poster child middle syndrome, like you came, I'm not sure. How were you adopted? I don't remember. So. Anyway. So it has been a wonderful time. Had a great time, really busy glad to have a little pre for a couple of weeks, but let's get in to the show. A couple of things. Hey, if you wanna leave a review, please do. So we need some Vicki for those. Who've been leaving reviews around the world that I can't see all the time, because apparently I, you know, with the podcast, you just see the American reviews. So I've seen a couple through come through my email through the worldwide. Reviews. I really appreciate that. Keep them coming because an Apple podcast who wants support us patrion.com/pandemic podcast for a small monthly donation or one-time through PayPal, Venmo all in the show notes. So one quick thing, I know we have a series of questions from our faithful listeners and we haven't gotten to them yet. Hold on. I want to get to them at some level. But I want to make sure Mark's available. And if you notice we've had some technical difficulties with Mark, I think he can lend a great voice to some of these questions I've been piling up. So we're not ignoring you by any means. We really appreciate them. And they're always in the forefront of our mind, but we're just finding the right time to do so. So please hold on tight for those who've set real questions. We want the answers to them. We'll do them as best as quickly as possible. So let's get in now, I guess I'll just go straight into the variant. Stephen because that's the big issue. You know, we, we recorded last Monday and we talked about it and you said, Hey, it's pretty clear. That's probably all around the world by now at some level. And then the next day, of course it lands in my own home state, at least formally acknowledged in Colorado. So now since then, I don't know where it's gone. I know Colorado, I think Florida or something or some other place it's been in, but I want to kind of throw it back to you to give us an update on this variant, because there are some things that seem to be concerning. You know, there was a New York time's article saying why it should be worrisome. And one little, one little graph. Now I'm always concerned about one little graph. There was mixed things. I feel like that it's a little more complicated that, but it showed Britain skyrocketing in cases, per million, compared to all the other countries around. Britain. So my question is to you is like, where are we at in this? And is that what we're seeing Britain going to happen to us? Is it expected or there are other variables in involved, but let's just, where are we at with this right now?
Stephen Kissler:Yeah. So I mean, as I said last week, it's, it's definitely concerning in a way that many other sort of developments or mutations in the virus have not been particularly concerning. This one is is as much more so And again, it all comes down to the fact that it really does look like it, it spreads substantially easier than than some of the other variants that we've seen as there's still a huge range of estimates around that amount, but it's pretty clear that it's more transmissible than, than the things that we've seen before. So. A couple of, we've gotten a couple of answers over the past week that we're still unclear when we last spoke about it. So did you give a quick rundown of those? Part of the reason why we think we might have first seen the variant in the UK is because the UK is doing a ton of genetic testing of the viruses. When they get samples, they're doing a lot of sequencing so that they can identify these kinds of variants very quickly. And so part of the question was. Is this a problem in the UK or was it just detected in the UK because they're doing they're, they're looking so hard for this kind of thing. My hunch last week was that it was detected in the UK and was not, you know, it was basically everywhere, but it had been detected in the UK and And that's beginning to change a little bit because many other countries, especially surrounding the UK that are also doing a lot of testing are now starting to see increases in that variant. But they had not detected them before. So I'm thinking about Denmark in particular where over the past four weeks, the, the relative prevalence of the new variant has grown from about a 10th of a percent to about two and a half percent, which means that it's starting to overtake the other strains just as we saw in the UK. Okay. So we've seen these graphs, for example, from the New York times where there are these huge spikes in cases in the UK which is, which is really alarming. And also, I mean, personally, I think you, and many of our listeners know that I, I lived there for about four and a half years. Yeah. And so, I mean, personally speaking, it's, it's just like heartbreaking to see you know, just this like hospitals being overwhelmed and ambulances having to wait outside because there's nowhere to unload people who are who who are sick. It's a, it's, it's a really difficult situation and is, is, is rapidly getting worse. So taking a step back, you know, what does this mean for us, for the world? It's true. So as, as we said, last week, the variant is very widespread. It's been detected in many different countries, you know, it's here, it's spreading. But I anticipate that we're a little bit earlier on, in our experience with this variant than places like the UK and seemingly like South Africa where they've really seen these big spikes and infections happening. There are a, a couple of things coming into play here. So in many ways, this is the worst possible time for a variant of this sort to emerge, right? Like, of course it is since April, I've been worried about the spread of the coronavirus. Precisely this week, right? Like the beginning of January, end of December, beginning of January, been saying from the beginning, like this was going to be the hardest time to control the coronavirus. And now here we are with not only dealing with the regular seasonal variation in the Corona virus compounded by the fact that we've just had some substantial holidays. Yep. Compounded by the fact now that we also have a more transmissible various, I think that that part of the UK story is that this was in many ways, the worst possible time for something like this to really start ramping up its spread. So, conversely, that means that for the rest of the world since the spread is just starting to take off, we do have a problem on our hands and we have something, you know, we, we really need to stay on top of this variant and I'll talk in a moment about how to do that. Okay. But yeah. Due to the timing of things. Hopefully we'll be a little bit further removed from our holidays. Hopefully we'll be a little bit closer to the spring. All of things that will help us get a little bit more control over this virus so that it's not really, you know, so that not all of those vectors are sort of moving in the same direction that are making it really difficult to control. So I don't want to sort of paint too rosy of a picture here. Like this is going to be very difficult to control. But I'm also hopeful that that I, I think that in many ways the UK has seen, seen the worst possible side of this. And so so we still have our work cut out for us, but but there's, there, there are sort of small slivers of hope there for ways that we can help maintain control now. All of the things that we know about that prevented the spread of the previous variants of the coronavirus work here too. Masking physical distancing might have to be a little bit more diligent about those things, sort of in proportion to the increased transmissibility of the virus. We have to be a little bit more diligent about those, those same. Those same measures because really the most important thing we can do is just reduce cases overall. Because that improves our ability to detect the variant to do the testing and the tracing that we need to do to really determine where it's spreading. So again, just bringing down cases as the most important thing we can do right now to give us one leg up on this this virus.
Matt Boettger:Yeah, I heard it was the CDC that said they're going to ramp up now again, I don't know the technical language of this, the type of testing to actually. Discover more of the variant where it's located, whatever it's called. So we're wrapping that up right now.
Stephen Kissler:Yeah. Yeah. And we're going to bring it up. I mean, it's, it's something I wish we could have done months ago, but but it's good that we're doing it now, you know, it's, it's badly needed
Matt Boettger:and, and in the qualify, this gets to the same stuff, right. There's no way we can kind of like surgically know in any way ahead of time, how to address the particular variants. We just have to kind of like do this general masking social distancing. Don't go to work. If you don't have to these kinds of things. Now, going back to its transmissibility, we talked about how. Well, there's no science this moment that it's actually more dangerous, that kind of stuff. At least in the sense of. Causing greater harm now as transmissibility can cause collateral damage significantly. Now, when it comes to increased transmissibility, do we know exactly why is it just the viral load that's actually, or, you know, how we went back in April and may and did, it's kind of like, I don't know if it's semantical argument or if it's actually like, is it airborne or is it, or is it molecules, has any that kind of language begin to just shift that goes, seems to be more airborne now? Or is there anything else being added equation or was it just. Viral load inside the individual body.
Stephen Kissler:Yeah. I mean, there've been a number of questions. There are a couple of different ways that a virus can become more transmissible. So one of them is that it shifts into different demographic groups. For example, then there was a lot of concern early on that maybe this variant might be more infectious and transmissible among kids. Now it's looking more and more like that is probably not the case or at least we don't have a lot of good evidence suggesting that. Okay. Even though there were seemed to be disproportionate rises of cases of this variant and kids of the UK. That's confounded by the fact that during the most recent UK lockdown schools stayed open. So so there was more mixing among kids, which could explain why we see the variant relatively increasing in those younger age groups. Second way that you can increase transmissibility is by extending the duration of time at what you're infectious. So basically lengthening the infection curve without actually ramping up virus. Okay. And there's still some ongoing studies about this, but some of the epidemiological modeling, basically you can ask, well, if that were the case, what would we expect to see in the numbers of cases and the numbers of hospitalizations that we're seeing, and those numbers just don't quite match up. Okay. So the, the, the clearest explanation that we have and this is also corroborated by By by sampling people is, is actually that they're producing more virus. Okay. Basically that for whatever reason, this, this variant allows you to make more virus in your nose and throat, which then makes you more infectious. And so increases the probability of airborne transmission to basically just. Makes more virus in the air, which makes a person more infectious, which makes it harder to connect.
Matt Boettger:Now, would it be fair then to say that we wouldn't go ahead going back in. So we've mentioned this a number, at least I have the parade of principle, the 80 20 rule. And so then we started in March talking about this and this and its concept. And how do we address the pandemic and it's virus then say seven months later, we talked about the parade of principal as like, Oh, it seems as though as this, the, the Corona virus is largely being transmitted. On a large level, through a small number of people. That's in fact, you know, a large group of people. So it was roughly 20% of the cases resolved 80% of the transmission with this variant. Is it safe to say that maybe the burrito, parents, principals being blown out of the water and it's no longer that 20%, but now it's 30 or 40 or 50% occurred. Of course, I'm just adding random numbers, but is it just, is it now it could be a lot now we're just getting a larger percent of cases being able to transmit it.
Stephen Kissler:Yeah. That's, that's what I anticipate. And it's, it'll be, it'll be interesting to know what exactly that That relationship is because again, again, there are two possibilities. One is that more people are crossing the threshold of infectiousness. So you're basically just having more infectious people in the population, or you might be taking that entire distribution, the number of people, a person's expected to infect and just multiplying it by a constant, which means the Pareto principle is still there. That you know, that, you know, 20% of the people cause 80% of transmission. But now instead of those. High 20% causing five infections they're causing 15. And so, so it's, it'll be, and, and, and it's important to get an answer to that question because that does change, change the way that we intervene. It really changes whether we still want to try to target the super spreading events, or if now we really need to focus on just sort of widespread community transmission more. And so that's, that's, that's something that we're really going to be working on answering as epidemiologists in the coming weeks. Okay.
Matt Boettger:So we'll stay tuned on that. We'll report back as this continues to develop related to this. Is the vaccine. You said you talked about this, that it's actually kind of the talk about the vaccine when to take it, how to take it. It's beginning to shift because of the variant before you, I give the mic back over to you to talk about this. I want to add one more caveat to this. And so you can lump these both in, I read this article a couple of weeks ago, so it's a little, little old. It said, should people take both Pfizer and maternal vaccines one after the other? It's not talking about what you should take, both meaning. Twice four times, the idea was I'll read this and then I want you to comment a lot of what you're hearing about the buzz about the variant and how we should be taking the vaccine and maybe incorporate into this kind of interesting concept. This comes from the article what's unknown is whether you didn't use an even stronger response with a different form of the coronavirus vaccine and immunology, the conference called heterologous. Prime boost. I don't, if I said it right. And some studies suggest that it might be more effective way to design vaccine regimens, especially for challenging diseases, such as malaria, tuberculosis, and HIV. Right? So this idea of taking maybe Pfizer for your first one, and then second one being the maternal one is how that might actually help things not add more on your plate. I just came to mind. So this is a lot. But you're going to go with it. I'll remind you is I saw the FDA thinking about cutting maternal vaccines in half the amount. So as to spread out more and get more vaccines that came alarm bells to me like, well, are we, are we losing the infectivity of this or so, so now in light of the craziest of the variants, re-examining right. How we do vaccines, which you talked about potentially cutting modern of vaccines in half. And then with this possible opportunity, talk about all this and how it works with
Stephen Kissler:the variant. Yeah. So on a broad scale again, as I mentioned last week, I think it still seems like the vaccines that we have available are effective against the variant. And so the the emphasis has shifted now to really sort of racing against the variant to try to get as many people vaccinated as possible that has raised All sorts of interesting ideas. And so really what we're trying to do is is, is we're in this difficult position where we have a specific set of evidence that comes from the vaccine trials themselves, and from our experience with other vaccines that we have in the past, like you sided with malaria and HIV and tuberculosis. So we're trying to integrate all of that information along with the specific information that we have about these particular vaccines and then project forward and ask, you know, what would happen if we do these things that haven't been specifically studied necessarily. But we're, we're in this, this crisis situation really where where some sort of action is demanded of us. So before I answer some of these specific questions, I just want to take a step back and say that, that Sort of from a high level, this, this reflects some of the some of the discussions we had way back in April about lockdowns. There were really a couple of camps that separated out. One of which said that we don't have enough evidence to suggest that lockdowns are effective. And we really need like solid. Randomized controlled trials in different communities showing that lockdowns are effective before we can do them. And that's a very sort of like concrete evidence-based way of making decisions. Now, on the other hand, there was a group that said, like, we have this emerging crisis and there's a lot of. Reason to think that lockdowns could be effective in reducing this and in the absence of further information we need to act now because we have a crisis on our hands and so we can collect the evidence as we go, but we need to do something. And, and that's a really interesting debate because that sort of sits outside of the realm of just like scientific fact, right. That that is an entire sort of philosophical underpinning of life. What is evidence and what is data and how do we incorporate those into the decisions and the actions that we make, basically what's the interface between ethics and data. And that's a much thornier question. So we're, we're sort of addressing these same sorts of things now with the vaccine is that we have sort of this, this lack of certain types of evidence that we wish that we had, but now we have this new variant that's running rampant and we have to, we have to act and we have to remember that even inaction. It was a type of action. And so, and so what do we do? Great. So now drilling into the question about the vaccine itself. So a couple of the of the approaches that I've that I've heard about that you just mentioned are one. That there could be this mixing and matching of of the different vaccine types. No, I think that this is not so much to speed up vaccination as it is to potentially induce a stronger immune response. Although if a community ran out of one type of vaccine, it could be helpful if they had the other one on hand to, to, to administer the other ones. So it could still help in this speeding up the vaccine progress now. I don't know an awful lot about The I think as you mentioned, the heterologous vaccine sort of protection and whether in this particular case of SARS, cov two, whether that would be more effective, but, but intuitively it makes some sense to me to expose yourself to slightly different types of the variant. And basically that broadens out your immune response which might make you More immune in some ways to new challenges, to slightly varying Corona viruses, because these things are always varying a little bit on some degree. So I think that's a really interesting question. But the most pressing question is what can we do to speed up the administration of vaccines? No. The UK I believe is considering if they haven't already approved a plan to basically delay the second dose. So they're giving a bunch of people the first dose, and then they're saying, we'll still give people the second dose, but we're just going to wait. Now of course, there, there isn't good evidence on this and people in the trials got the first vaccine and then, then like clockwork got the second vaccine for the most part. So we don't really have good evidence of what happens if you delay that second dose immunologically based on what we've seen from previous vaccines. It still seems likely that that will be pretty effective. And so that, that people will still sort of Mount a good second immune response, but of course, SARS, cov two is a different virus than these other things have been studied on. And so the dynamics of immunity are different. So we, we are sort of treading into unknown waters, but, but we need to because again, I mean, you saw those, those case rates in the UK and there. They're climbing really fast. And so I think there's a really good case to be made for immunizing as many people as possible, as quickly as possible. Now, the second idea that that has come up is potentially giving people half doses. Of the modern of vaccine. So rather than giving the full, I think a hundred milligram dose, you get 50 instead. But you still do your two doses right on schedule. So that has a similar effect of doubling the number of people you can vaccinate with the same number of of doses, but doing it in a, in a way that's a little bit closer to the way that the trials were run now. The vaccine trials that that, that we have for both Madrona, I mean, all of the vaccine trials are still ongoing. So we're still collecting data from the people who are in the trials. They've entered into phase four as well. So we're following people up who have gotten the vaccine in this new wave and. Part of the motivation for doing the half dose with the modern vaccine is that it is actually based off of this continuation of their trial in which they've been, they've been following people who got the half. So the vaccine and recent evidence that just recently came out, suggests that the people who got that half dose actually do Mount. Just as good of an immune response as the people who got the full dose. So this is now grounded, a little bit more firmly in evidence in evidence that we specifically have about this specific vaccine, which makes a lot of people a lot more comfortable with administering it in this way. So I think that there are a lot of other ideas that are going to be tossed around, but this was sort of the way in which we're starting to think about them now. Of course there are a lot of issues with this as well, where you know, with changing the vaccine dosing with changing the vaccine timing, there's questions of efficacy, there's questions of duration of immunity. And there's also been these emerging questions of could. That changed the way that the virus itself is evolving to maybe make it easier for the virus to evolve resistance to the vaccine and put us in a difficult spot as well. Now there's a lot of good studies out there on why it's harder to develop. Resistance to a vaccine than it is to develop resistance to a pharmaceutical treatment. I needed to review sort of the nuts and bolts of that before I can talk into that. Maybe we can talk about that next week. But those are things that we're working on and things that people are really asking questions about now is like, what are all of the potential implications of this both in the immediate term? For preventing the spread of this new variant, but also in the longterm, making sure that we don't get an even bigger problem on our hands.
Matt Boettger:No, but I'm glad you mentioned that one thing just a couple like a minute ago, because when you're talking about, Oh, you know, the, by doing half dosages and there's maybe ideas of how could this affect the virus. This is the exact same thing that, again, I know it's just pure speculation that we think could have been a contributed to causing the actual variant of it was the pharmaceutical treatments. Right that maybe prolonged the virus in the body that made it mutate and that kind of stuff. And Lord, I would not want that to be part of the vaccine agenda as well to have a stronger mutation. So we're important next week to see how that works. Kind of goes straight into the U S and how seeing there's 4.2 million doses have been given so far up to basically the end of December. And the goal was 20 million, which were far off, far off from, we see Israel heading 10%, the first in the world, temps of the population, getting the vaccine. Do you have anything to contribute to why this may have happened? Why we fallen short or like you just said more people need to, and I'm guessing at least. I'm sure systems have failed. That's a big issue in part of the equation is getting more of the vaccine, like you said, by half dosages, giving more people. But if we don't have the right systems, it's still going to be July before we get everybody and not to add one more thing, but I signed up yesterday to be notified. When I'm up from my turn of the vaccine and there was like 17 categories and a little bit sad. And then I had actually scrolled the very, very, very bottom. And I had to click the last radio button. That was, that was me the very last possible choice. Basically. It was like, all else, click here. I'm like, okay, well, I'm going to be at the very end, so that stinks, but I'm happy to give it to the people who need it first. But do you want any, anything you want to get insight you want to contribute to where we're at right now with the vaccine and where we need to be.
Stephen Kissler:Yeah. I mean, it's a, it's, it's disheartening to see that we're lagging so far behind sort of what we hoped we would be able to achieve with vaccination. I don't have any clear answers for why that's the case. You know, other than that, you know, in a way I think that some of us were kind of caught flat-footed because we. Got two vaccines, you know, that about as quickly as we possibly could. It's not really an excuse. I mean, we did have a year to start developing these, you know, these, these vaccination plans There is a lot of complexity to, to this. And, and some of it just comes from the structure of our healthcare system in the United States, our system of governance in the United States. So again, the deployment of vaccines is apt to largely up to States and communities. There's been very little federal guidance, but then there's also been a lot of confusion on the state level with each of them trying to come up with their own plans. The the fact that we have a very complex health system where people have different insurances for different places, make it really difficult to be proactive. And that's really what we need. We need healthcare providers to be actively seeking out people to Offer the vaccine to them. And instead we're in the scenario where the onus is on the individual to sign up for getting a vaccine in, in ways that are often pretty convoluted. You know, it just personally speaking, like I've spoken with various people who are like trying to get a vaccine and there's just not very clear protocols and the, and it wasn't even clear. Where to do it or how to do it, or the followup was you sort of got different messages in different places. And I mean, it's, it's really is not, not, not the situation you want to be in where you're trying to vaccinate huge amounts of your population very quickly. I don't know what exactly has gone wrong, but but there's, there's clear places to fix. And I think that, that the clearest is to be proactive in, in, in reaching out to people. To notify them and directly offer them the vaccine in whatever way we can. And I don't know what the solution to that is, but but we need it.
Matt Boettger:Yeah, absolutely. It kinda reminds me and this is not taking a political stance at all. It's just the idea of. When you live in a country that really embraces, I don't want to say it seems like radical descendant countries, but extreme autonomy. Right. So I get to choose. There's a lot of great benefits from that, but also that when you create a system that actually is a support that then the onus becomes more and more on you in good ways, but also bad ways. Like, well, if you want it right, it's up to you to get it, buddy. Because when I saw it, I got an email. And I literally had to stop my, my son's birthday party for second go to the bathroom. Like I, the way I read, I was like, Oh, well, it'd be, you'll be notified for some like, press release. I'm like, well, where's the press release going to be like, I have no, or click here in side of the world. This is my only chance. And I got to sign up and get it. Otherwise I have no idea which press release. I'm going to be notified and which channels. So. I really encourage you guys to dig, find it. Hopefully your County Boulder County here in Colorado has done a great job. At least letting me letting me know where I could sign up and in five seconds and be notified when my time is available. I don't think I wanted to bring up to you. Hey, this is kind of related. It's. It was a hopeful thing that I saw yesterday and then I didn't clip it. And so I didn't know where it was at, but I was shocked to read. That said evidence shows that natural immunity may last up to a decade. And I was just like, Whoa, because you know, up to this point, we're thinking, Oh, maybe a year at max. And we're seeing a lot of people at six to eight months re getting COVID and where did 10 years come from? Some of the throat pesty I'm like, have you seen anything to even suggest this? And, and where is this? Anything that could be valid?
Stephen Kissler:Yeah. I mean, so. I think that we can, we can sort of add this to the pile of studies that are trying to answer exactly how long immunity lasts. Now with any of these studies, especially things that make claims about the duration of immunity, that's longer than we've had the virus with us. We have to take it with a massive grain of salt because yeah, what's happening here is that we want to know essentially what is that distribution? You know, how many people, what percentage of the population is going to have immunity for? What amount of time? Huh? That's the key. And what we're trying to do is to measure that in, in ways that sort of get at that, whereas the only way to actually measure it is to actually measure it, to actually follow people for a year, for five years, for 10 years, and to see how many of them, what proportion of them get reinfected. And then that you know, that's that's then how we know what that distribution is. But instead, what we're trying to do is to sort of. Look around the corner, you know, obliquely get at that, that information by measuring things like the duration of immune response in the human body and sort of trying to extrapolate how long, different immune cells last and incorporate the proportion of people who we've observed get reinfected and then try to make statistical inferences about the population based on how rare or not rare those events are. And so you can, you can do some very good science around this to try to figure out how long it's going to last. But you know, the fact is we, we just don't know, we're not going to know for awhile. And, and I think that, you know, I think it is possible that that natural immunity to the coronavirus in some cases could last for a very long time. There's a whole continuum of what immunity means. Does that mean protection from infection? Does that mean protection from disease? Does that mean, you know, like how does that stand up depending on how old you are, how severe your exposure was or how many times you've been re-exposed in the meantime, all of a sudden the questions just compound and compound And so sure. I believe that that some people will have very long lasting at the end of due to the coronavirus. And clearly some others have very short lasting immunity. The coronavirus really what we want to know is what's that mean what's the variance around the mean and, and to measure that we just need a lot of observations over a long period of time, which it's still going to be a little while before we know that. So that's, that's sort of the skeptical lens that I'm taking towards. These different studies, all of them are important. All of them are contributing something to our knowledge of the duration of immunity. But pulling any one of them out and sort of taking their claims on, on, on any direction I think is, is, is difficult. Because right now we just have so many different studies that say so many different. Thanks. And so it's best to sort of take them all in their aggregate and then also take a step back and realize it, realize sort of scientifically what they're doing, which is trying to get at this question from different angles. None of which are the direct angle that we really need, but which we won't be able to answer for for a number of years. Yeah.
Matt Boettger:Okay. And again, have you coverage, I'm sorry, I'm going all over the place. Different questions because you'll say something like, Oh yes. What about this? The other burning question, this kind of related to immunity in that is the vaccine. Anything on the glimmer of idea of whether that vaccine will prevent transmissibility from the person or this keeps themselves from actually getting it, but it's still can transmitted, but that's still up, up, up up for grabs.
Stephen Kissler:To my knowledge is still up for grabs. I have no, no additional clarity on that question yet, man.
Matt Boettger:I'm so excited to get that answer, hopefully. Okay, so now a couple more questions. One quick one. This is from weeks ago, I don't have to get enough sand, right? Illume COVID test. I read this and I thought of you thinking this is the answer, right? FDA authorizes first, rapid. Over the counter home coronavirus tests from the Washington post. I read a little bit. Is this one of those things we've been talking about? We're like, yes, we finally get at-home tests. We're looking for, especially with this variant now is the time to get it. Is this we're looking forward to the FDA approve this or is this another one of those? Well, maybe, maybe kind of different.
Stephen Kissler:Yeah. It's another, well, maybe kind of, kind of different, unfortunately. It's so. It is the type of technology that we're talking about. It's a rapid antigen test that can be administered at home which is great. And I think really what this is pointing to is sort of this, this focus on, on the technology when really what we need are our other things. It's more logistical considerations that are, that are standing in our way at this point. So the Aluma test that you just mentioned. Runs on this sort of rapid antigen tests, the paper strip tests like we've been talking about, but it connects with your phone via Bluetooth. And then it reports out the result to your, to your phone, which means that there's like electronics involved and that makes the test more expensive and you need to get it with a prescription. You can't just pick it up over the counter. And so that increases all of these barriers because you need to be able to pay for a physician visit and then. To pay for the test and then to get it at your home after picking up a prescription. And so, again, by that time, there's, there's these delays, there's these monetary barriers. And it's, it's like relatively complex to produce. It's a lot more complex than just printing off a bunch of paper sheets with these primers on them. And so that reduces our ability to sort of produce them at high volume. There've been a couple of others that have been given emergency approval as well, but all of them sort of suffer from the same the same issues. Not all of them are electronic, but all of them are sort of more involve more materials than these paper strip tests, which sort of raises the barrier to their access. And all of them need a doctor's prescription. So none of them are yet really what we're looking for, where we need people to be testing themselves frequently, cheaply, you know, across the population. And really the only barrier right now is, is regulatory and logistical. And and that's, that's the reality we're in. So again, it's like encouraging because these are absolutely steps in the right direction, but it's like, there there's. We just haven't crossed the finish line here. That drives me nuts, but that is what's. Okay. Yeah.
Matt Boettger:We're close. We're getting closer, but I was hoping that was the answer. Last question. It's a big one, but I thought what, why let's not ask it. Let's go ahead and ask it. We had a few, few minutes to spare for the BBC. We've talked about it for Stephen. You've talked about this and at least five to 10 to 15 minutes in detail, but let's bring it back again. Are pandemics the new normal now pandemics have been going on forever. Right? And now with this variant, there's a lot of fears with, it's going to go on forever. This is going to end. We're going to have this. There's going to be a normalcy, but one day, Sunday, there's going to be another pandemic. No. Do you see in your work, working with your colleagues who are on different areas and different expertise, do you see a future by which pandemics are going to be more prevalent than what we see in the past 500 years or so? Or do we see this being roughly the same? And if you do get in pure speculation, what could be some of the contributors that would, that would elevate the, the, the number of times we receive one.
Stephen Kissler:Yeah. So I have a note of pessimism and a note of hope. So I'll start with a note of pessimism. So on the one hand, I think that it's hard, like sort of talk about the frequency of relatively rare events like pandemics, you know, it's like, what does it mean for them to be more frequent? I'm not sure, but I think that there, there are good reasons to believe that that are. Society today is in some ways at higher risk of certain types of pandemics than we have been in the past now, clearly we've been, as you've said, subject to pandemics for, you know, forever. And and so this is not something that's really new. But of course, so some of the issues are that, you know, we're, we're very. Globalized world. Right? We have people moving all over the world, which allows the transmission of viruses and other pathogens to happen very quickly to be very widely disseminated, very early on. We have with Acceleration of, of climate change and you know, different animal habitats are being sort of shifted in important ways. Humans are increasingly encroaching on different animal habitats and, and these animal reservoirs are where a lot of you know, that's really, what we're concerned about is, is pathogens crossing over from animals, into humans and then continuing to spread, you know, that said, we sort of have this sense of like, like humans encroaching on the forest and this kind of thing, but like also like. Yeah, farming can yeah. Contribute to some of those too. And, and, and that's not to say that like farming, you know, like we need to eat, right. We need to farm. But just realistically speaking, you know, like things like avian influenza, like we have cases of flu crossing over from birds, into humans all the time. And thankfully, usually those strains don't transmit from human to human very well. And so they don't cause issues, but we have flu evolving in. Farmed bird populations and swine populations and all sorts of different places that include both wild animals and then also domesticated animals, as well as in humans, ourselves, where, where pathogens are evolving. So so there are all sorts of different ways for for for basically pandemic pathogens to emerge. And. While a lot of the, you know, we've had, we've had agriculture for forever. We've been encroaching on animal habitats for forever. And so, you know, these things are not necessarily new, but I think we do need to be paying close attention to the way in which they're happening, the rate at which they're happening. And then all of these things can contribute to potentially an increase in the risk of of another pathogen and other pandemic. Yeah. And, and the rate of them could, could very well increase. I want to put in an important note that that pandemics look very different for one another, you know, less, less we forget. HIV is a pandemic and you know, tuberculosis has been at various points in its history, considered a pandemic, some consider it still to be one. So we have respiratory illnesses. We think about Corona viruses. We think about flu, but there are also, you know, HIV, HIV, and other types of illnesses that cause all sorts of different types of disease that require different types of interventions. And so I think we can also, there's a danger of sort of being in this tunnel vision of like a COVID
Matt Boettger:like
Stephen Kissler:panic. But that's not necessarily what we what's going to happen next. It could be something that spreads in an entirely different manner. It could be waterborne, it could be sexually transmitted. It could be, you know, what have you. But we need to be sort of preparing for all of these things. So. The note of hope, what does it mean to prepare? So one of the really interesting ideas that I think I'm really excited about here and this has been proposed by Michael Mina and collaborators, but many other people are sort of thinking about this is that they, they recently wrote a paper in the journal eLife, which I can send sent to you, Matt. Basically talking about what they're calling a global immunological observatory to work alongside something that's been previously called a global pathogen observatory. And so basically the idea behind these two different things is to be running consistent surveillance, both for the presence of virus, using things like PCR tests and antigen tests for virus, bacteria, other sorts of pathogens and parasites. And now in addition with the global immunological observatory to actually be looking at Sort of these micro blood tests to see if people have antibodies to different types of pathogens. And what that allows you to do is to both detect the presence of virus itself. But then also if there is a pathogen starting to take hold in a specific community, you can actually sort of look back in history and see if people have been exposed to that pathogen and starting to do this surveillance to see both. Are they infected now or have they been infected at any point in the past? To give you a lot better insight for the emerging spread of these different types of pathogens. And you know, why stop at humans? We can do this same sort of thing in different animal reservoirs, like bats and birds, and these kinds of things that we know are our sources of crossover. And we can do the same sort of testing the same sort of. Immunological testing and pathogen testing in these reservoirs where we know that crossover is a concern to try to get one leg up on these crossovers before they happen, or to understand sort of what the most likely pathogens are that are posing a threat to humans and really watching out for them to see if they start to develop the potential for human to human spread. So I think that's a really exciting area here and something that that we're starting to invest a lot of work into where the idea is to start to try to build some of these like sort of climate type in weather type forecasts for. The spread of infectious diseases that I think will, will sort of help counteract this threat of increasing greater pandemics in the future. It's a bit of a long shot still. You know, we still have a lot of technology to produce a lot of infrastructure to put in place, but I think that that really is A place to pin some of our hope for the coming century, in our relationship with him.
Matt Boettger:I think it's a great hope. I mean, just, you know, to use the word Serge, this is about another potential surge, but a good surge of opportunities for work and employment that like, I know it's in the midst of a crisis where we're finding unemployment and I get it. It's very, it's very specific and, and, and just sad for the people have lost her job. And the hope that the aftermath of this is there's going to be not just. Thousands of little epidemiologists trying to clamor for, to be under Stephen, but there's going to be all over the place. Ecology and global climate. I mean, this is just going to explode, like you said, there's so much even technological infrastructure. It's not there because we haven't put our focus into it. It's going to be all over. I mean, there's going to be places for entrepreneurship and everywhere for the next hundred years, that's going to benefit. Globally the whole healthcare system of humanities. So this is, this is the hope. This is the excitement and the midst of a really difficult hardship as we end. I don't know if you can answer this. There was a question brought up open. It's all transparency. Can't see, actually the question. So I'll take it off, but I'll read it here. I don't know if you can say, speak into this. Not sure if you guys are taking live questions from John. But here it goes. T-cells verse. Okay. But can I say this immunoglobulin globulin seems like T-cell is longer lasting any indication on whether M RNA versus viral vector Oxford are more likely to produce a T cell response, anything in your neck of the woods that, that hint to one of these.
Stephen Kissler:Great question. So absolutely right. That for SARS cov two, it looks like the immunoglobulin response does decline substantially over time. And that was behind a lot of these early concerns that immunity might not last long at all, but then there were these up studies that said, well, wait, there's T cell immunity. That seems to be lasting and seems to be able to allow your body to remember. What it's been exposed to and to Mount a response that way. But that's a great question that I don't have an answer to yet. I'm not sure, sort of what the proportion of of of an immune response that's induced by the vaccine. I anticipate that, I mean, since these vaccines have been really engineered to Expose the body to, as close to a replica of the pathogen. And like the specific parts of the pathogen that your immune response would respond to. Anyway, I anticipate that there'll be a similar response, but I'll follow up on that and see if I can give a better answer next week. Okay,
Matt Boettger:great. So you heard of John Stephen we'll follow up. We'll keep him accountable. Thank you guys. All for listening for the one person watching today. We appreciate all the feedback and all those who who've asked questions and they will come and answers as soon as we can get to them. I hope you guys. Had a wonderful, wonderful, happy new year. Hope. It's a great start to the new year and that stay away from making resolutions cause resolutions suck and they go away after about three weeks, be more intentional with your life and we will hopefully see you all next week. Next Monday, take care. And bye-bye.